Migraines (Exam 2)

Question 1

Migraines are diagnosed based on

Answer 1

TWO of these features:
-Unilateral head pain
-Throbbing pain
-Worsens with activity
-Moderate / Severe pain

ONE of these features
-N/V
-Photophobia (avoid light)
-Phonophobia (avoid sound)

Question 2

Migraines Characterized by

Answer 2

A headache that last anywhere from 4 to 72 hours

Question 3

Migraine: Classification

Answer 3

Aura present (motor symptoms) (visual) (sensory)

Aura not present (most common)

Chronic
(15 days / month for 3 months)

Question 4

What is the most common type of migraine?

Answer 4

Migraine without an aure present

Question 5

Migraine Risk Factors

Answer 5

Family history

Estrogen and Progesterone
(WOMEN)

Genetic Factors
+
Environmental factors

Question 6

Migraine Triggers

Answer 6

-Fatigue

-Sleep Disturbance (too much or too little)

-Missed meals

-Overexertion

-Weather

-Stress

-Hormone changes

-Alcohol

-Bright light or strong smells

Question 7

Migraine: Pathophysiology

Answer 7

Change in neurotransmitter levels in CNS

Increase neuronal depolarization

Neurotransmitter stimulate vasodilation

Blood vessel tone

Question 8

Clinical phases of Migraine

Answer 8

Premonitory phase

Migraine Aura

Headache phase

Recovery Phase

Question 9

Premonitory phase

Answer 9

First stage

1/3 of people have:
-fatigue
-irritability
-loss of concentration
-stiff neck
-food cravings

Question 10

Migraine Aura

Answer 10

Secondary stage

Up to 1/3 have aura symptoms lasting up to 1 hr

Visual
Sensory
Motor

Question 11

Headache phase

Answer 11

3rd phase

Throbbing pain on one side of head that spreads to entire head

Headache may have:
Fatigue, nausea, vomiting, dizziness, hypersensitivity to touch on head

Last 4 to 72 hours

Question 12

How long does the headache phase last with migraine?

Answer 12

4-72 hours

Question 13

Recovery phase

Answer 13

Last stage before migraine resolves

Irritability - fatigue - depression

Hours-Days

Question 14

Abortive Therapy (treating symptoms)

Answer 14

First:
-Aspirin like drugs (NSAIDS - ASA-Acetaminophen)

Can add:
-Serotonin Receptors Agonists (triptans) (sumatriptan)

For people you can not tolerate Triptans:
-Calcitonin Gene-related Peptide (CGRP) Antagonist

Question 15

When is abortive therapy most effect?

Answer 15

When given early in the course of the migraine

Question 16

sumatriptan: Class

Answer 16

Serotonin 1B/1D Receptor Agonists

Acute treatment for migraine

Question 17

sumatriptan: MOA

Answer 17

Constrict intracranial blood vessels

Suppress release of inflammatory neuropeptides

Block brain pathways for pain

Question 18

sumatriptan: Adverse Effects

Answer 18

-Injection site reaction (SQ)

-Chest pressure

-Flushing

-Weakness

-Headache

-Bad taste

Question 19

sumatriptan: NSG consideration

Answer 19

-Avoid with history of ischemic stroke or heart disease

-Avoid with angina

Question 20

rimegepant: Class

Answer 20

CGRP Antagonists

Question 21

rimagepnat: Indication

Answer 21

Used for Acute Migraines with triptans are not effective / contraindicated

-CAD or Stroke or Angina

Question 22

rimegepant: MOA

Answer 22

Mediates pain transmission

Question 23

rimegepant: Adverse Effects

Answer 23

GI Upset

N/V/Abd pain

Question 24

rimegepant: NSG consideration

Answer 24

CYP substrate

Used to treat acute migraine when triptans arent effective or contraindicated

Question 25

When is preventive therapy for migraines used?

Answer 25

4 Migraine per month or migraine lasting longer than 12 hours

Question 26

Migraine Preventive Therapy Drugs

Answer 26

Beta Blockers -propranolol Tricyclic Antidepressants -Amitriptyline Antiepileptic drugs -divalproex -topiramate Estrogens -menstrual migraine

Question 27

Preventative Therapy Goals

Answer 27

Reduces attack frequency severity and duration Improve responsiveness to treatment of acute attacks Improve function and reduced disability Prevent progression or transformation of episodic migraine to chronic migraine